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General NPI Number Information
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NPI Number | 1871677708
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Entity Type | Organization
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Legal Business Name | RANDALL L WEISEL, DDS, PA
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3700 E BAY DR
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City | LARGO
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State | FL
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Zip | 33771-1935
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Country | US
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Telephone | 727-536-5787
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Fax | 727-530-9630
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Provider Business Mailing Address
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Address Line | 3700 E BAY DR
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City | LARGO
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State | FL
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Zip | 33771-1935
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Country | US
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Telephone | 727-536-5787
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Fax | 727-530-9630
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL L WEISEL
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Credential | DDS
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Telephone | 727-536-5787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN0010195
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License Number State | FL
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